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After a Concussion, When’s the Right Time for Athletes to Get Back in the Game?

Written by Brian Krans
on
June 4, 2015

Klay Thompson is starting for the Golden State Warriors tonight in the NBA Finals, a week after sustaining a concussion. Is this a good idea?

If the Golden State Warriors’ shooting guard Klay Thompson isn’t feeling well, it may simply be because of the nerves and anxiety that come with playing in the NBA Finals.

“I feel great honestly,” Thompson told ESPN on Wednesday. “These last few days I feel like I've gotten my wind back, and tomorrow's the final tuneup.”

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Since last Thursday, it’s been uncertain if Thompson would be suiting up for tonight’s initial playoff game against the Cleveland Cavaliers.

Thompson, 25, took Houston’s Trevor Ariza’s knee to the head during Game 5 of the NBA Western Conference Finals. He didn’t finish the game and later showed telltale signs of a concussion, including feeling ill and vomiting a few times.

Thompson didn’t practice with the Warriors on Friday or Saturday, but he was back on Monday. By Tuesday he was given the green light to suit up against the Cavs.

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Kim Gorgens, Ph.D., clinical associate professor at the Graduate School of Professional Psychology at the University of Denver, said Thompson’s time off the court was crucial to his recovery.

“That doesn’t mean he’ll be completely asymptomatic,” she said. “He’ll probably have to push harder. I’d be surprised if he’s at 100 percent.”

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The decision to play wasn’t his to make. Thompson, like all NBA players diagnosed with a concussion, must receive the OK from the team’s medical staff.

Dr. Vernon Williams, a neurologist and member of the California State Athletic Commission who has treated numerous professional athletes for concussions, said the primary obligation of medical professionals is the health and safety of the athlete.

“There are a number of reasons you want to ensure a player is safe to return to play,” he said. “We know the highest risk of a second injury is 10 days after a concussion.”

A second injury before the first is healed is called second impact syndrome, which can be fatal or leave lasting cognitive disabilities

Concussions Get the Treatment They Deserve

The days of athletes “walking off” potential concussions to continue playing are slowly becoming as antiquated as playing in Chuck Taylor shoes.

Considering the average concussive impact for an athlete is 95 times the force of gravity, experts no longer consider head trauma as simple as a player “getting his bell rung.”

Dr. Barry Jordan, chief medical officer of the New York State Athletic Commission and a team physician for U.S.A. Boxing, said the issue became a priority when former NFL players began showing the long-term effects of repeated head trauma, including behavioral, physical, and cognitive problems.

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“This has been a major problem in boxing, but no one cared about it,” he said.

Creating a Brain Baseline

In the preseason, all players in the NBA — which Gorgens calls “fairly progressive” compared to other professional sporting organizations — complete a Standardized Assessment of Concussions, which tests memory and recall. This gives athletic trainers a baseline to judge against in the case of head injury.

This baseline also gives an objective measure in case an athlete attempts to downplay his or her injury so they can rejoin their team, Dr. Harry Kerasidis, a cognitive neurologist and co-founder of the concussion tracker XLNTbrain, said.

“It’s a tough situation,” he said. “There are conflicts of interest that abound.”

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When an athlete experiences a concussion, they’re assessed by medical staff, and rarely return to play because a second concussion before the first is healed can drastically increase healing time. When it comes to head injuries, rest is the best medicine.

For the most part, these concussions are self-healing, which is a good thing. We do know the majority of concussions do recover within seven to 10 days.

Dr. Barry Jordan, New York State Athletic Commission

“For the most part, these concussions are self-healing, which is a good thing. We do know the majority of concussions do recover within seven to 10 days,” Jordan said. “If they continue to play, the recovery will take longer.”

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They’re then assessed through a “stepwise” method where their symptoms are judged first at light activity leading up to full exertion, much like how Thompson eased back into his practice schedule.

But in sports like basketball, too much time off the court can also impact a player’s endurance, so too much time off isn’t necessarily a good thing.

“The NBA is a tough sport when it comes to conditioning,” Williams said. “The key is when they’re ready, they’re ready.”

Changing How Injuries Are Assessed

Previously, the decision to give a player a clean bill to return to the game was made with a stringent checklist. For example, a grade 1 concussion automatically benches a player for two weeks and a grade 2 for two months.

Now, experts allow the concussion to run its course so the severity can be determined when symptoms subside. Overall, this has reduced a player’s time off the field

The guidelines athletic trainers use are a culmination of studies, papers, and opinions of medical experts from a variety of medical and sporting organizations. The expertise of the medical professional is an important one in determining when a player is ready to return to play.

The key is to take it on a case-by-case basis. Each concussion is different.

Dr. Vernon Williams, California State Athletic Commission

“The key is to take it on a case-by-case basis. Each concussion is different,” Williams said. “We always say if you’ve seen one concussion, you’ve seen one concussion.”

In his upcoming book, “Concussionology: Redefining Sports Concussion Management,” Kerasidis explains these guidelines and dispels myths about sport-related head trauma.

“A lot of people mistake if there’s no loss of consciousness there’s no concussion,” he said. “That simply isn’t true.”